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ETHICAL ISSUES IN COUNSELLING PRACTICE

Ethics is a way of thinking about becoming the best practitioner possible. Ethical guidelines
do not make decisions for you and ethical sensitivity is required, often viewpoints differ but in
the end you have to assume responsibility.

Mandatory ethics: view of ethical practice that deals with the minimum level of professional
practice

Aspirational ethics: a higher level of ethical practice that addresses doing what is in the best
interest of the client

Positive ethics: an approach taken by practitioners who want to do their best for clients rather
than simply meet minimum standards and stay out of trouble.

Negative ethics: following proscribed behaviour as set out in ethics documents

Putting the client’s needs before your own:

- Cannot completely separate your needs from those of your client


- Be aware of own needs/ unfinished business/ personal conflicts/ defences
- As yourself: whose needs are being met? Yours or the client’s?
- Meeting your own needs at the expense of the client is an ethical issue
- Must expand own self-awareness and recognise areas of our own areas of prejudice
and vulnerability
- Counsellors should engage in self reflection and monitoring / supervision/ therapy
- Subtle personal needs that may get in the way of creating growth producing
relationships:
o Need for power and control
o To be nurturing and helpful
o To change others in the direction of our own values
o To persuade
o To feel adequate esp. if we are looking to the client to confirm our own
competence
o To be respected and appreciated
These needs should be met outside of client work if we are to help others find satisfaction in
their lives.

Ethical decision-making:

- Professional organisations do not provide ready made answers


- Must draw own conclusions from ethics codes
- Learn which resources you can draw on

The Role of Ethics Codes as a Catalyst for Improving Practice

Professional ethics codes serve a number of purposes:

- They educate counsellor and client/public re expectations and responsibilities


- They provide a basis of accountability
- They protect clients from unethical practices
- They provide a basis for reflecting and improving professional practice (self
monitoring is a better route for professionals to take than being policed by an outside
agency)

Ethical behaviour must not be confused with legal behaviour. Unfortunately ethics codes
can take on a legal dimension and practitioners are more concerned with avoiding a
lawsuit than about doing what is right for the client – limiting their creative work.
To prevent being sued for malpractice you should:
- Demonstrate respect for clients
- Keep their welfare as a central concern
- Practice within professional codes

Ethics codes are best used as guidelines in making sound judgements and not hold ultimate
truths.

Some Steps in Making Ethical Decisions

1. Identify the problem, gather information, decide if it is ethical, legal, professional,


clinical or moral dilemma
2. Identify the potential issues (rights, responsibilities, welfare)
3. Look at relevant ethics codes
4. Consider applicable laws and regulations
5. Seek consultation from more than one source
6. Document in client records the suggestions you have received
7. Brainstorm various possible courses of action (with others and client and document)
8. Enumerate the consequences of various decisions
9. Reflect on implications for the client
10. Decide and continue to follow up to evaluate outcomes
11. Document the reasons for the actions you took and evaluation measures

The more subtle the problem the harder it is to decide on a course of action. Be willing to
discuss the problem and explore various options. Keep the client involved.

The Right of Informed Consent:


- Is a legal and ethical requirement
- Creates a foundation for a working alliance and partnership
- Includes the right of the client to be informed about their therapy and make decisions
- Empowers the client and creates a trusting relationship

Includes:
- General goals
- Responsibilities of counsellor
- Responsibilities of client
- Limitations and exceptions of confidentiality
- Legal and ethical parameters
- Qualification and background of counsellor
- Fees
- Service that can be expected
- Length of process
- Benefits/risks
- Possibility of discussion with other colleagues

Begins at the first session and continues throughout the process. Must balance too much and
too little info.
It is a good idea to have the basic outlines in paper which can be discussed.

Dimensions of Confidentiality:

Two aspects:

1. Privileged communication
Legal concept barring disclosure of confidential communication in a legal proceeding
2. Confidentiality
An ethical concept and in most places a legal duty of the therapist not to disclose
information about the client
- Therapeutic relationship is based on trust, must explain to client the limits, nature and
purpose of confidentiality early on including discussion of the case with supervisors
- Breaching confidentiality is a cloudy issue and the following must be considered:
o The law, nature of the institute you work for and repercussions for client

- However, confidentiality must be broken under the following circumstances:

o Child abuse
o Abuse of elderly
o Abuse of dependant adult
o Client under 16 may be victim of incest, rape, child abuse or another crime
o Client needs hospitalisation
o Court issue
o Client requests files be released to selves or third party

The counsellor’s primary obligation is to protect client.

Ethical Issues In a Multicultural Perspective:


Take clients cultural context into account for ethical practice

Are current theories adequate in working with culturally diverse populations?


- They can and should be expanded
- Traditional theories often bear little or no relevance to some clients (old school)
- They must incorporate an interactive person in the environment focus
o Salient cultural and environmental variables must be taken into account
- Therapists must use strategies congruent with values and behaviours of a pluralistic
soc.

Is Counselling Culture-bound?

- Theories represent different world views


- Traditional theories were largely created by white western, middle class males
- They have distinct limitations when applied to special populations and minority groups
- Value assumptions made by counsellors can lead to culturally biased counselling and
the under use of health services
- Contemporary approaches: origin: euro-America: not necessarily value neutral or
applicable to everyone. Their key values are based on individual choice and
autonomy while some cultures value collectivism and group decision making
- (Individualism vs. collectivism)
- NB: listen to clients: why are they here? How can I best help them?

Focusing on Both Individual and Environmental Factors

- Theory provides a guideline however multicultural practitioners follow other


assumptions too:

o The individual must also be viewed in context of his/her family and culture
o Social action is favoured rather than increasing individual insight
o Maintain the notion that therapeutic practice is only effective if it changes the
factors creating the client’s problem (a social action), not blaming/working
with the individual alone

- Difficult for counsellors to bring about change in society, counsellors can use
techniques to increase client awareness of options when dealing with barriers and
struggles.
Ethical Issues In the Assessment Process:

Both clinical and ethical issues come into play when considering assessment and diagnostic
procedures.

The role of assessment and diagnosis in counselling:

Both assessment and diagnosis are an integral part of the therapeutic process and regardless
of orientation therapists need to engage in assessment.

Assessment: can be considered part of the process leading to diagnosis. Is an going process
consisting of evaluating relevant client factors in a client’s life to identify themes to be
explored

Diagnosis: consists of identifying a specific disorder based on a set of symptoms.

Both are useful in planning treatment

Psychodiagnosis: analysis and explanation of a client’s problems and can include:


- Possible causes
- An account of how they developed
- Classification of disorders
- A specific, preferred treatment procedure
- Estimate of successful resolution

The purpose of diagnosis is to identify disruptions in a client’s present behaviour and lifestyle.
This allows goals as well as a treatment plan to be established. It also acts as a working
hypothesis for the therapist. Therapists use the Diagnostic and Statistical Manual of Mental
disorders.

Some see diagnosis as unnecessary / detrimental / discriminatory / counter productive/


inability to relate to the client as a purpose and creates self fulfilling prophecy

Considering ethnic and cultural factors in assessment and diagnosis:

- Diagnostic approach may fail to notice ethnic and cultural factors in certain patterns of
behaviour
- DSM does acknowledge this encourages awareness of it
- Cultural bias can lead to erroneous diagnoses
- Some behaviours and personality styles may be labelled as deviant because they are
not characteristic of the dominant culture

A Commentary on Assessment and Diagnosis:

- Can we bridge gap between the poles of diagnosis seen as essential and as
detrimental?
- Can be collaborative event - client and therapist both engage in the search and
discovery process
- Some counsellors avoid diagnosis but share tentative hypotheses with client
throughout the process (consistent with feminist theory)
- Ethical dilemmas: diagnosis for insurance purposes
- Clinical/ legal/ ethical obligation to screen clients for life threatening problems: organic
disorders, schizophrenia, bipolar, suicide and depression
- Assess whole person: mind/body/spirit
- Must take biological processes into account and work with physician
- Holistic perspective: spiritual and religious too
- Client’s own values can be used in finding solutions to their problems
The Value of Evidence-Based Practice

Instead of using techniques based on their preferred theory, there has been a promotion
towards evidence-based practice.

- Push counsellors to use empirically supported techniques


- Make them accountable for there interventions
- Keep them up to date on current trends
- It may mandate types of interventions used in the future
- However it is hard to determine what counts as evidence
- Pressure towards using brief and standardised interventions
- Treatments are operationalised and come with a manual
- Many practitioners are against this (mechanical and mass produced)
- Only works for clients with specific concerns
- And the client itself accounts for much of the outcome, successful or not
- Potential abuse of research and evidence by interested parties

Dual and Multiple Relationships in Counselling Practice

- Sexual /nonsexual occur when the counsellor assumes two or more roles
simultaneously or sequentially with a client.
o Either more than one professional role or,
o Combines professional and non professional roles
- Non sexual relationships: teacher/therapist, supervisor/therapist, borrowing money
from a client, providing therapy to a friend/employee/relative, social relationship with
client, accepting an expensive gift from a client, going into business with a client
- Some multiple relationships can be exploitive can do harm to both parties
- Unethical: becoming emotionally or sexually involved with a current or former client
- Nonsexual dual relationships are complex – few simply answers
- Nonsexual, dual and multiple relationships are complex so there are few concrete
answers
- Give careful thought to your situation before becoming involved in questionable
circumstances
- Counselling professionals must learn to manage multiple relationships in an ethical
way specifically regarding:
o Power differential in counselling / training relationships
o Balancing boundary issues
o Addressing non professional relationships
- Multiple relationships that would not reasonably be expected to cause impairment or
risk exploitation or harm are not unethical

Perspectives on Dual and Multiple Relationships

- Difficult to recognise, unavoidable, potentially harmful, beneficial


- Hotly debated apart from sexual engagement which is unethical
- Sexual intimacy is unequivocally unethical
- Most codes are against dual relationships
- Are inevitable: interpersonal boundaries are not static
- Must remain alert to possibilities of damage and exploitation
- Must manage boundary fluctuations and overlaps
- Must minimise risks involved

Ways of minimising risks


- Does potential benefit outweigh potential harm?
- Set healthy boundaries early including informed consent
- Include client in on going discussions and the decision making process
- Consult with fellow professionals
- Work under supervision when difficult, document consultation and actions
- Self monitor
- As yourself: can the relationship be avoided? May not be in rural communities